I leave a note for my roommate and drive the four blocks to the ER. To my horror, the same doctor who sent me home on Christmas Eve a year before is on duty. As he enters the exam room and looks at my chart, he visibly bristles while reading what I can only assume are the notes from my last visit and more than likely the complaint I registered along with notes from the other hospital that I had submitted.
Good. We have his attention.
I sit through hours of periodic breathing treatments which at this stage, is minimally helpful. But I try to make the best of the wait until they admit me for more effective treatment. I tend to revert to humor. It’s my go-to response, passes the time and fosters some good interaction with those around me. I just have to be careful to not actually laugh. As I’ve mentioned, emotion of any kind at this stage will aggravate the symptoms. There is a group of interns who are all too eager to see and hear a live asthmatic wheezing and coughing. I consent while breathing on my “peace pipe” of a Nebulizer.
Finally the doctor approaches me and says, “I don’t know what more I can do for you. What is the typical course of treatment at this point?” Is he really asking me what he should do? I am not sure if I should be relieved or scared as hell that he is resorting to asking me. I decide on the latter. I can hear in the tone of his voice that the only reason he hasn’t already sent me on my way is because of the complaint I registered last time. He clearly hasn’t bothered to consult with any other doctors about how to treat my symptoms. More importantly, he doesn’t understand how dire this is. I stifle the brief panic that arises from deep inside. No emotion.
I fix my eyes on his and muster what I can of my voice and say as authoritatively as I can, “I am not leaving. I need to be admitted. They usually give me an IV drip of Solu-Medrol (liquid form of prednisone) and it would be a good idea for you to take a chest x-ray because I have a history of developing a pneumothorax and doctors have told me to monitor that.” He obliges.
They put me in a room with another woman and when I arrive, she has visitors. We have a curtain between us for privacy. My breathing is more labored now, having been to radiology. A chest x-ray requires you to take a deep breath and hold it; an impossible task. Breathing has long since departed the full trajectory of a normal pattern deep into the lungs. And the coughing is increasing.
I’m getting scared. This is reaching a new level and I know it. I focus on taking short, shallow breaths while checking for a pneumothorax. This becomes my rhythm.
There! There it is. The Rice Krispie crackling of air bubbles underneath the skin. @*&#%!!
I have a pneumothorax. Air is leaking into the space between my lung and chest wall. The knowledge of this is creepy. I MUST control my coughing. I press the call button for a nurse. She comes in and I whisper to her that I believe I have a pneumothorax. She looks surprised that I would say such a thing but she checks anyway. “I don’t feel anything.”
I’m going to die in this hospital because these people won’t listen to me!
I want to cry but I can’t. No emotion. I feel the control slipping away. Everything tunnels as the obstructed airway through which I am breathing constricts further. The airways to the lungs are inflamed and irritated; they are swelling while the smooth muscles are tightening. The cells produce more mucus which clogs in the airways; like drinking a fresh strawberry milkshake and chunks of strawberry get stuck in the straw. Only in this case, it’s your air supply that is clogged.
It is paramount that I control the coughing. I feel what I call the “scary cough” approaching and it takes everything I have to suppress it. I dubbed it the “scary cough” when I was five years old. Your body is violently hurled into a coughing fit which completely drains you of air. You instinctively want to take in a huge deep breath. It’s like being under water for too long and you’re trying to reach the surface but it’s farther than you thought it was. You have breathed out all of your air and your lungs are screaming to be replenished but it’s another 10 yards to the surface. When you reach it, your body desperately breathes in an enormous dose of air. With this kind of coughing fit, you can’t take in that deep breath. Your lungs are empty, but the airways are obstructed. If you take in that rush of air too fast, it will launch you back into coughing. It’s a violent pattern and once you are in it, it’s difficult to control. It’s like getting the wind kicked out of you repeatedly.
I know I have a pneumothorax but they aren’t feeling it. I have to fight. I tunnel. I focus. I force myself to still.
Someone else arrives. “Hi, my name is John. I’m a respiratory therapist. The nurse said you believe you have a pneumothorax?” I nod. “You’ve had one before?” I nod. His tone feels different from the others. “Can you show me where you feel it?” I show him and I think the simple fact that I know how to check for it catches his attention. He checks. “You’re right. There it is. I feel it right here. Okay, I’m not going far. I just need to call the doctor, okay? I know it hurts and I’m going to get you another treatment. I’ll be back shortly.”
The nurse’s station is right outside of my room within earshot. I hear him except for the names of the doctors he mentions. “I need Dr. ‘X’ and Dr. ‘Y’ here NOW and I need those chest x-ray results immediately. This girl knows what she’s talking about. Who was the ER Dr. on duty when she came in?” This girl knows what she’s talking about. Wow. He believes me! His tone is terse and direct. He’s pissed. My angel has arrived.
My breathing is on the edge. I feel the scary cough emerging. I try in vain to force it into dormancy. It erupts. I stay as calm as I can through the first round, but my body surges into a second, and then a third. I can’t take it. I’m white knuckling the sidebars on the bed as I expel all of my air for a fourth time and then I feel it. A sharp pain shoots up the left side of my back and I know; I instinctively know that my lung has just collapsed.
I have no air. It’s gone.
I am in acute respiratory distress but I cannot communicate that to anyone. I lie down and repeatedly press the call button for the nurse. There is still no air.
This is it. I’m 19 years old and I am about to die. That sucks. I’m not ready.
I hear a nurse’s voice over the intercom and she asks me what I need. I can’t respond. I keep pressing the button. She rushes in. Thank God.
There is a flurry of action. I hear “code blue” over the paging system and I know it’s for me. What a strange feeling. I still have no breath, but I am calm. Several people burst into the room. One pulls the curtains around us and asks my roommates’ visitors to leave. Someone is straddling me but not sitting on me.
A needle stabs my arm. The liquid burns as it enters my vein.
They are asking me questions. I can’t respond.
I feel small, welcomed but labored pockets of air emerge. They get me stabilized and rush me down the hall to the intensive care unit. The doctor asks if I have family here. I don’t. I whisper, “Idaho.” He has to put his ear up to my mouth to hear me speak. He gives me something to write on and I write phone numbers for my mom back home, my roommate and another local friend.
They have to insert a chest tube between my third and fourth ribs to drain the excess air in the chest cavity in order to make room for the lung that has collapsed. Because of the severity of what just happened, they are afraid to give me any anesthesia for the procedure or medication for the excruciating pain associated with a lung rubbing against other organs as it struggles to re-inflate in a space which is too small for it at the moment. It was god-awful.
I can handle a great deal of physical pain. I’ve never experienced anything like that before or since. For two days, I moan audibly. John, the respiratory therapist is with me between his rounds during his 48 hour shift. He literally holds my hand for 10, 20, 30 minutes at a time and checks on me constantly. I couldn’t have made it through without him.
The day after it happened, one of the ER nurses who had been on duty when I arrived pays me a visit. The ER doctor did not. She tells me how sorry they are that it had gotten so serious and that they are shocked that it took such a horrible turn so fast. My lung collapsed less than an hour after I was finally admitted. I give her a deliberate, stoic stare. I still can’t really talk but I think it communicated my thoughts rather well.
I’m so glad I am still here.
That was more than twenty years ago but the details of that day are solid in my memory. My lung would collapse again but by that time, I was back at Kootenai Medical Center and received over-and-above outstanding care. I remember telling them all how much I loved them. Granted, I was rather happy on pain medications at the time, but given the difference between this and my first experience, I think love was the right word.
So, how can I possibly live an active, adventuresome lifestyle including endurance racing and rarely have to use my rescue inhaler? Some of that answer may surprise you. I can’t wait to share and my biggest hope is that other asthmatics will be encouraged to keep pressing on and perhaps learn something new about how to control their symptoms on a more permanent basis. Please stay tuned.
Here’s to life without limits.